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Overview

While vaccines remain the best strategy to prevent COVID-19, recent evidence suggests monoclonal antibodies (nMABs) or antivirals could potentially benefit certain vulnerable populations before or after exposure to SARS-CoV-2, such as the unvaccinated or recently vaccinated high-risk patients.

With the recent roll out of nMABs and antivirals, there is an urgent need to for knowledge and understanding around the use of nMABs and antivirals in the treatment of patients with COVID-19, such as factors of relevance in determining nMAB and antiviral treatment and the impact of nMAB and antiviral treatment in the community and hospital settings.

This OpenSAFELY report..

The code and data for this report can be found at the OpenSafely antibody-and-antiviral-deployment repository.

Introduction

Methods

Results

Coverage of COVID-19 treatment

Between 01-Nov-2021 and 01-Feb-2022, a total of 4,210 non-hospitalised patients registered at a TPP practice in England were identified as being eligible for receiving a nMABs or antiviral for treating COVID-19 (Figure 1). Within the same time period, a total of 3,340 patients had received a nMABs or antiviral treatment for COVID-19 (Figure 2);

  • Paxlovid: 210;
  • Sotrovimab: 990;
  • Remdesivir: 930;
  • Molnupiravir: 1,000;
  • Casirivimab.200,

For all subsequent analysis by high risk cohort, patients identified as being eligible for receiving a nMABs or antiviral for treating COVID-19 have been included within each high risk cohorts that their records indicate they fall into. Out of the 4,210 eligible patients, 4,170 (99%) were included in two or more high risk cohorts (range 1 - 7).

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Figure 1: Cumulative total of patients eligible for receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.

Figure 1: Cumulative total of patients eligible for receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort. Note, eligible patients can appear in more than one high risk group and the overall number (pre 10th February 2022) in each group is likely to be an overestimation due to including patients where their SARS-CoV-2 infection is confirmed by a lateral flow or polymerase chain reaction test.

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Figure 2: Cumulative total of patients who received a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group

Figure 2: Cumulative total of patients who received a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohorts. Note, treated patients can appear in more than one high risk group

Delivery of nMAB and antiviral treatment

Figure 3: Weekly proportion of eligible patients receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort and treatment type

Figure 3: Weekly proportion of eligible patients receiving a nMABs or antiviral for treating COVID-19 since 11th December 2021, stratified by high risk cohort and treatment type

Table 1: Proportion of eligble patients who have recieved treatment for COVID-19 since 11th December 2021, broken down by high risk cohort and treatment type
Treated
Eligible
All
Paxlovid
Sotrovimab
Remedesivir
Molnupiravir
Casirivimab
High risk cohort Count Count % Count (%) Count (%) Count (%) Count (%) Count (%)
All 4040 3340 83 210 (6) 990 (30) 930 (28) 1000 (30) 200 (6)
Rare neurological conditions 1470 1190 81 70 (6) 360 (30) 350 (29) 340 (29) 70 (6)
Sickle cell disease 1180 950 81 70 (7) 270 (28) 270 (28) 290 (31) 60 (6)
Haematological diseases and stem cell transplant recipients 1140 920 81 70 (8) 270 (29) 230 (25) 290 (32) 60 (7)
Immune-mediated inflammatory disorders 1050 840 80 50 (6) 250 (30) 240 (29) 250 (30) 50 (6)
Solid cancer 1020 780 76 50 (6) 220 (28) 220 (28) 240 (31) 40 (5)
Renal disease 820 650 79 50 (8) 190 (29) 170 (26) 200 (31) 40 (6)
Down’s syndrome 800 640 80 40 (6) 190 (30) 190 (30) 180 (28) 40 (6)
Primary immune deficiencies 620 510 82 20 (4) 160 (31) 140 (27) 150 (29) 30 (6)
Liver disease 620 480 77 40 (8) 140 (29) 140 (29) 130 (27) 30 (6)
Immuosupression due to HIV or AIDS (CD4 <350 cells/mm3) 600 490 82 30 (6) 150 (31) 140 (29) 140 (29) 30 (6)
Solid organ transplant recipients 440 350 80 20 (6) 120 (34) 90 (26) 100 (29) 20 (6)

Key demographic and clinical characteristics of treated patients

Table 2 shows the number and proportion of patients who had received treatment by 01-Feb-2022, broken down by demographic and clinical categories and treatment type.

Table 2: Count and proportion of eligible patients who have received treatment for COVID-19, broken down by demographic and clinical categories and by and treatment type
Treated
Eligible
All
Paxlovid
Sotrovimab
Remedesivir
Molnupiravir
Casirivimab
Group Variable Count Count % Count (%) Count (%) Count (%) Count (%) Count (%)
Age band 12-29 940 730 78 39 (5) 230 (32) 198 (27) 220 (30) 40 (5)
Age band 30-39 520 420 81 25 (6) 130 (31) 118 (28) 120 (29) 20 (5)
Age band 40-49 560 440 79 36 (8) 120 (27) 142 (32) 120 (27) 30 (7)
Age band 50-59 580 460 79 31 (7) 130 (28) 136 (30) 140 (30) 30 (7)
Age band 60-69 500 390 78 27 (7) 110 (28) 105 (27) 120 (31) 30 (8)
Age band 70-79 280 230 82 6 (3) 70 (30) 64 (28) 80 (35) 10 (4)
Age band 80+ 190 160 84 13 (8) 40 (25) 38 (24) 60 (38) 10 (6)
Age band Unknown 640 510 80 34 (7) 160 (31) 131 (26) 140 (27) 40 (8)
Sex Female 2180 1730 79 99 (6) 520 (30) 489 (28) 530 (31) 90 (5)
Sex Male 2040 1610 79 112 (7) 470 (29) 443 (28) 470 (29) 110 (7)
Ethnicity White 830 660 80 43 (7) 200 (30) 170 (26) 200 (30) 40 (6)
Ethnicity Asian or Asian British 800 640 80 34 (5) 190 (30) 204 (32) 180 (28) 30 (5)
Ethnicity Black or Black British 820 640 78 46 (7) 170 (27) 190 (30) 190 (30) 40 (6)
Ethnicity Mixed 790 620 78 39 (6) 190 (31) 172 (28) 180 (29) 40 (6)
Ethnicity Other ethnic groups 770 610 79 38 (6) 180 (30) 156 (26) 200 (33) 40 (7)
Ethnicity Unknown 210 160 76 11 (7) 50 (31) 40 (25) 50 (31) 10 (6)
IMD 1 most deprived 860 670 78 31 (5) 220 (33) 186 (28) 190 (28) 50 (7)
IMD 2 860 670 78 40 (6) 190 (28) 193 (29) 210 (31) 40 (6)
IMD 3 820 650 79 44 (7) 190 (29) 185 (28) 200 (31) 30 (5)
IMD 4 860 690 80 48 (7) 200 (29) 172 (25) 220 (32) 50 (7)
IMD 5 least deprived 760 610 80 48 (8) 170 (28) 186 (30) 180 (30) 30 (5)
IMD Unknown 50 50 100 0 (0) 20 (40) 10 (20) 10 (20) NA (NA)
Rurality Urban - conurbation 1090 860 79 51 (6) 270 (31) 234 (27) 270 (31) 50 (6)
Rurality Urban - city and town 1050 850 81 53 (6) 260 (31) 252 (30) 220 (26) 60 (7)
Rurality Rural - town and fringe 1020 810 79 52 (6) 230 (28) 220 (27) 250 (31) 60 (7)
Rurality Rural - village and dispersed 1050 820 78 55 (7) 240 (29) 226 (28) 260 (32) 40 (5)
Region East Midlands 420 340 81 13 (4) 100 (29) 82 (24) 120 (35) 20 (6)
Region East of England 410 320 78 26 (8) 100 (31) 93 (29) 80 (25) 20 (6)
Region London 790 630 80 34 (5) 170 (27) 175 (28) 200 (32) 40 (6)
Region North East 420 330 79 22 (7) 110 (33) 87 (26) 100 (30) 20 (6)
Region North West 430 340 79 17 (5) 100 (29) 102 (30) 90 (26) 20 (6)
Region South East 430 350 81 26 (7) 100 (29) 96 (27) 100 (29) 20 (6)
Region South West 420 320 76 23 (7) 90 (28) 99 (31) 90 (28) 20 (6)
Region West Midlands 420 340 81 22 (6) 100 (29) 84 (25) 120 (35) 20 (6)
Region Yorkshire and the Humber 470 370 79 28 (8) 110 (30) 114 (31) 100 (27) 20 (5)
Autism autism_nhsd 1320 1060 80 68 (6) 320 (30) 300 (28) 310 (29) 60 (6)
Care home care_home_primis 620 480 77 30 (6) 150 (31) 133 (28) 140 (29) 30 (6)
Dementia dementia_nhsd 40 30 75 2 (7) 10 (33) 10 (33) 10 (33) NA (NA)
Learning disability learning_disability_primis 870 680 78 40 (6) 200 (29) 180 (26) 210 (31) 50 (7)
Serious mental illness serious_mental_illness_nhsd 420 340 81 22 (6) 110 (32) 91 (27) 90 (26) 20 (6)
Housebound housebound_opensafely 40 40 100 4 (10) 10 (25) 9 (22) 10 (25) NA (NA)
CEV shielded_primis 50 40 80 3 (8) 10 (25) 6 (15) 10 (25) NA (NA)
Vaccination status Un-vaccinated (declined) 420 330 79 20 (6) 120 (36) 84 (25) 90 (27) 20 (6)
Vaccination status Un-vaccinated 430 340 79 23 (7) 90 (26) 110 (32) 100 (29) 20 (6)
Vaccination status One vaccination 420 340 81 21 (6) 100 (29) 92 (27) 100 (29) 30 (9)
Vaccination status Two vaccinations 830 680 82 40 (6) 200 (29) 205 (30) 200 (29) 30 (4)
Vaccination status Three or more vaccinations 2110 1650 78 107 (6) 480 (29) 441 (27) 520 (32) 110 (7)

Concordance with guidance

Of the 3340 patients who received treatment for COVID-19 between 01-Nov-2021 and 01-Feb-2022, # A tibble: 1 × 1, n, , 1 2725 patients were missing records needed to confirm eligibility. It is likely that most, if not all, of these patients meet all of the eligibility criteria and non of the exclusion criteria but, for example, their SARS-CoV-2 test result is not available in their record or we just do not have access to all the criteria the clinician might use to assess high risk group status (such as the patients identified via non digital methods).

Figure 3: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility

Figure 3: Breakdown of eligibility criteria variables in treated patients with missing records needed to confirm eligibility

Time to treatment

Figure 4a: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by treatment type

Figure 4a: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by treatment type

Figure 4b: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by high risk cohort

Figure 4b: Time between positive SARS-CoV-2 test and treatment for COVID-19, broken down by high risk cohort